Clinical practice regarding Pneumocystis pneumonia in Japan: A nationwide web-based survey by the Japanese Respiratory Society

<bold>Background:</bold> Pneumocystis pneumonia (PCP) is an opportunistic infection that primarily occurs in patients with impaired cellular immunity and often causes respiratory failure. According to the EORTC/MSGERC diagnostic criteria in 2021, if a host with impaired cellular immunity has symptoms and CT findings compatible with PCP and an elevated serum b-D-glucan level, anti-PCP treatment is allowed regardless of the results of microbiological tests. However, it is unclear how clinicians perceive this criterion. <bold>Methods:</bold> To investigate the clinical practice regarding PCP in Japan, we conducted a nationwide web-based survey in 2023, and valid responses were obtained from 292 members of Japanese Respiratory Society. <bold>Results:</bold> Among the respondents, 259 (89%) were board certified physicians. Regarding their workplaces, 31% were at university hospitals and 63% were at community hospitals. Only 8 respondents answered that they would definitely perform bronchoscopy on patients suspected of PCP, and 119 (41%) said that they would perform it on more than half of them. 170 (58%) answered that they would use PCR in more than half of cases of suspected PCP. The 2021 EORTC/MSGERC criteria were perceived by 247 (85%), but 14% of the respondents were reluctant to introduce anti-PCP treatment despite negative PCR results. Treatment with reduced dose trimethoprim-sulfamethoxazole (7.5-12 mg TMP/kg/day) was preferred by 43%. <bold>Conclusion:</bold> Many Japanese pulmonologists supported treating patients with elevated serum b-D-glucan levels as PCP even in the absence of microbiological evidence. Although reduced doses of anti-PCP drugs have gained some support, further investigation is required.